Many Children With Hearing Loss Also Have Eye Disorders

About one-fifth of children with sensorineural hearing loss also have ocular disorders, according to a report in the February issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.

An estimated one to three per 1,000 children have some degree of sensorineural hearing loss, which occurs as a result of damage to the nerves or the inner ear, according to background information in the article. Half of all cases in children result from environmental causes and half from genetic causes; one gene, GJB2, accounts for a large proportion of sensorineural hearing loss cases in white patients.

“Especially early in life, sensorineural hearing loss is associated with delays in language, speech, cognitive and social development,” the authors write. “Given the effects of hearing impairment, children with sensorineural hearing loss are particularly dependent on other means of information acquisition. If these children were to have unrecognized ophthalmologic abnormalities that limited visual acuity, there could be further detrimental effects on development.”

Arun Sharma, M.D., of the University of Washington, Seattle, and colleagues reviewed ophthalmologic findings in 226 patients with sensorineural hearing loss who were seen at a children’s hospital between 2000 and 2007. Of these, 49 (21.7 percent) had an ophthalmologic abnormality, including 23 (10.2 percent) with refractive errors (including nearsightedness, farsightedness and astigmatism) and 29 (12.8 percent) with non-refractive errors. The cause of sensorineural hearing loss was syndromic (having other symptoms associated) in 11 patients (4.9 percent), and 5 (2.2 percent) had syndromes with related eye problems.

All participants were offered genetic testing for mutations in GJB2. Of the 144 patients who underwent this screening, 27 (18.8 percent) had two mutated copies of the GJB2 gene, and one (3.7 percent) of those had ophthalmologic abnormalities. This compares with none of the 11 patients with a single copy of the mutated gene and 22 of 106 patients (20.8 percent) with no mutations. “This is consistent with the impression that GJB2 mutations result in sensorineural hearing loss but not in additional anomalies or syndromes,” the authors write.

“A multidisciplinary approach is important in the evaluation and treatment of children with sensorineural hearing loss to ensure that their medical, education and social needs are met,” the authors conclude. “Ophthalmologic evaluation can be beneficial for patients by allowing ophthalmologists to diagnose (and possibly treat) co-existing disorders that affect vision and by helping otolaryngologists to determine the cause of sensorineural hearing loss.”

Arch Otolaryngol Head Neck Surg. 2009;135[2]:119-123.

Archives of Otolaryngology-Head & Neck Surgery
archotol.ama-assn

Final CMS Rule Increases Eye Code Payments To Ophthalmologists

The 2008 Medicare Physician Fee Schedule issued by the Center for Medicare and Medicaid Services (CMS) this week means an increase in payments for ophthalmology of $154 million, or approximately 2 percent over existing payments. However, the increase could be more than offset by a 10.1 percent reduction in payments under the flawed sustainable growth rate (SGR) formula unless Congress intervenes to stop the cuts.

“Convincing the AMA RUC committee and CMS about the importance of increased eye visit code payments is the result of two years of hard work that has paid off in the new rule. These increased payments more accurately reflect the value of the services provided by physicians,” said Michael X. Repka, MD, secretary for federal affairs for the American Academy of Ophthalmology. “Our focus now is on trying to convince Congress to prevent the across-the-board cuts that we are facing from the SGR formula and implement a minimum two-year positive update.”

Among the considerations that the CMS used to determine the new payments was a recommendation from the Relative-Value Update Committee (RUC) of the American Medical Association (AMA) to adjust payments for eye visit codes to reflect increases instituted in 2007 for evaluation and management services.

However, the new fee schedule would also implement a more than 10 percent reduction in physician payments, as mandated under the sustainable growth rate (SGR). SGR links Medicare reimbursement payments to the nation’s gross domestic product, which bears little correlation to the cost that physicians face in providing patient care.

The Academy is working with the AMA and other groups to press Congress to prevent the cuts from being implemented and to pass a positive rate update for a minimum of two years. The two-year update gives physicians some stability and would allow Congress time to develop a long-term solution that corrects the problems created by SGR.

Ophthalmologists are also facing another payment decrease, as CMS continues to phase in new data on practice expenses. As a result, ophthalmologists face another 1 percent decrease in 2008. The Academy has called upon CMS to update the data for all specialties in the same manner and is working with the AMA to develop a new medicine-wide survey, which is expected to improve future payments to ophthalmology.

In addition to the increase for eye visit codes and the impending cuts, the new fee schedule also implements a number of other changes of importance to ophthalmologists. These include:

– As part of the Physician Quality Reporting Initiative, CMS will provide an approximate 1.5 percent bonus for physicians who voluntarily report on quality measures during calendar 2008.
– CMS has approved five new retina codes. The codes replace or modify several existing codes.

The American Academy of Ophthalmology is the voice for ophthalmologists and their patients in Washington D.C., and is the world’s largest organization of eye physicians and surgeons, with more than 27,000 members.

aao

$16 Million Grant From State Stem Cell Agency To Speed Research Of Stem Cell-Based Treatment For Age-Related Macular Degeneration

Physician-researchers at the University of Southern California (USC) received a nearly $16 million grant from the California Institute of Regenerative Medicine (CIRM) to fund the development of a stem cell-based treatment for age-related macular degeneration, the leading cause of vision loss and blindness among the elderly.

Mark Humayun, M.D., Ph.D., professor of ophthalmology, cell and neurobiology, and biomedical engineering at the Keck School of Medicine of USC and the USC Viterbi School of Engineering, and David R. Hinton, M.D., Gavin S. Herbert Professor of Retinal Research and Professor of Pathology and Ophthalmology at the Keck School of Medicine, will lead the four-year study.

CIRM and two international partners awarded more than $250 million to 14 multidisciplinary teams of researchers in California, the UK and Canada to develop stem cell-based therapies for 11 diseases. The Disease Team Research Awards mark the first CIRM funding explicitly expected to result in a filing with the FDA to begin a clinical trial.

The grants received formal approval today from the Independent Citizens Oversight Committee (ICOC), the 29-member governing board of the institute, and were announced at a press conference held in Los Angeles.

USC faculty will also collaborate on grants awarded to other California institutions:
Paula Cannon, Ph.D., associate professor of molecular microbiology and immunology at the Keck School of Medicine, is a co-investigator on a team that received $14 million to develop a novel therapy that may offer lifetime immunity to HIV infection.

Thomas Coates, M.D., professor of pediatrics and pathology at the Keck School of Medicine, is a co-investigator on a team that received $9 million to explore treating sickle cell disease using a gene therapy approach to modify patients’ blood-forming stem cell.

Michael Press, M.D., Ph.D., Harold E. Lee Chair in Cancer Research at the USC Norris Comprehensive Cancer Center and professor of pathology at the Keck School of Medicine, is the co-investigator on a nearly $20 million grant aimed at developing drugs that destroy cancer stem cells in solid tumors.

Age-related macular degeneration (AMD) is a progressive disease that causes distortion in central vision and eventually leads to blindness. It is estimated that by 2020, more than 450,000 Californians will suffer from vision loss or blindness due to AMD. Effective treatment for the disease may be achieved by replacing damaged retinal pigment epithelium – the layer of cells at the back of the eye – and retinal cells with healthy ones derived from human embryonic stem cells, Humayun said.

“The funding from CIRM will be tremendously helpful and will accelerate our research towards achieving a near-term stem cell based therapy for AMD,” he said.

Humayun was elected this month to the prestigious Institute of Medicine for his groundbreaking work to restore sight to the blind. Election to the Institute is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service.

CIRM President Alan Trounson said the pace of the Disease Team projects stands in contrast to the decade or more that’s usually required to reach clinical trials.

“Scientists have talked for years about the need to find ways to speed the pace of discovery. By encouraging applicants to form teams composed of the best researchers from around the world we think CIRM will set a new standard for how translational research should be funded,” he said.

Source: Meghan Lewit

University of Southern California

Report Recommends Increased Disability Benefits For Veterans

The 13-member Veterans’ Disability Benefits Commission on Wednesday released a report that recommended as much as a 25% increase in disability benefits for veterans as compensation for lost “quality of life,” the AP/Boston Herald reports. The 544-page report, based on a 2.5-year study, included 113 recommendations to improve the disability benefits system for veterans.

According to the report, the Department of Defense and the Department of Veterans Affairs have not provided veterans with adequate disability benefits or mental health care. The report found that veterans who have post-traumatic stress disorder might not receive adequate care because of a lack of coordination among federal agencies and that VA often does not re-examine veterans who might have PTSD, in part because of efforts to reduce a backlog of disability claims.

Recommendations
According to the report, “Congress should increase the compensation rates up to 25% as an interim and baseline future benefit for loss of quality of life, pending development and implementation of quality of life measures. In particular, the measure should take into account the quality of life and other nonwork-related effects of severe disabilities on veterans and family members.”

The report recommended a shift in responsibility for assignment of disability benefits to VA, which in many cases rates disabilities higher. The report also recommended that VA expand use of technology to reduce the average delay of 177 days for distribution of disability benefits to veterans and that veterans receive benefits for all service-related injuries, regardless of whether they occurred during combat. In addition, the report recommended mandatory re-examinations every two to three years for veterans who might have PTSD (AP/Boston Herald, 10/3). The report called for the establishment of an “executive oversight group” to implement the recommendations (Yoest, CQ Today, 10/3).

Retired Army Lt. Gen. James Terry Scott, chair of the commission, said, “We have come up with 113 recommendations — some of them are cheap. Some are easy. Some are extremely hard and complex. Some of them, there is a significant bill attached to it. But what we’re hoping is that the Congress carefully looks at all 113.” Senate Veterans’ Affairs Committee Chair Daniel Akaka (D-Hawaii) said that the committee will review the recommendations in the next few weeks (AP/Boston Herald, 10/3). Senate aides said that implementation of the recommendations might cost as much as hundreds of billions of dollars over the next 10 years (CQ Today, 10/3).

Eye Injuries
In related news, several lawmakers have introduced a bipartisan bill (HR 3558) that would provide $5 million to establish a DOD center for research and treatment of eye injuries among veterans, USA Today reports. In addition, the legislation would establish a database to help track treatment of veterans who experience eye injuries to provide military physicians and VA with their complete medical histories. According to the Army, at least 1,126 veterans of the wars in Iraq and Afghanistan have experienced eye injuries that require surgery, and half of those veterans experienced temporary blindness in at least one eye.

Eye injuries account for 10.7% to 13% of all serious wounds among veterans of the wars in Iraq and Afghanistan that require evacuation from combat, according to current and former Army ophthalmologists. Thomas Zampieri — director of government relations for the Blinded Veterans Association, who plans to testify on Thursday at a House Veterans’ Affairs Committee hearing — said, “It still is hard for us to understand how such a significant injury as combat eye wounds could have been below everyone’s radar screen for four years of war” (Zoroya, USA Today, 10/4).

Broadcast Coverage

NPR’s “All Things Considered” on Wednesday reported on the report. The segment includes comments from Joe Violante, national legislative director for Disabled American Veterans, and Scott (Shapiro, “All Things Considered,” NPR, 10/3). Audio of the segment is available online.

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

New-Generation Silicone Hydrogel Contact Lenses Can Alleviate Some Common Problems Of Soft Contact Lens Wear, Study Shows

While nearly 88 percent of
all computer users will develop Computer Vision Syndrome at some time in
their lives according to the National Institute of Occupational Safety and
Health, a new nationwide study of Americans’ attitudes and experiences with
vision care reveals that contact lens wearers are more likely than
non-wearers to experience at least one of the symptoms often associated
with the disorder. Now, new research demonstrates that the use of
new-generation silicone- hydrogel lenses (senofilcon-A) can alleviate some
of these problems.

Nearly half (45 percent) of computer users report they at least
sometimes experience dry or tired eyes during or after using a computer,
but contact lens wearers are significantly more likely than non-wearers (57
percent vs. 43 percent) to describe these symptoms. Furthermore, one-third
of contact lens wearers (36 percent) polled say they experience contact
lens discomfort while working at a computer according to findings from
Americans’ Attitudes and Perceptions About Vision Care, a nationwide survey
of more than 3,700 adults conducted by Harris Interactive(R) on behalf of
The Vision Care Institute(TM) of Johnson & Johnson Vision Care, Inc.

“The unique characteristics and high visual demands of computer work
make many individuals, particularly contact lens wearers, susceptible to
the development of eye and vision-related problems,” explains Dr. Jeffrey
Anshel, a practicing optometrist and author of Visual Ergonomics in the
Workplace. “Research shows that while using a computer, we blink about
three times less than normally. These long non-blinking phases can cause
the surface of most contact lenses to dry out, which can lead to extreme
discomfort and a loss of visual clarity.”

A study published in the current issue of Eye & Contact Lens, the peer
reviewed journal of the Contact Lens Association of Ophthalmologists,
demonstrates that contact lenses made with senofilcon A, a new-generation
silicone hydrogel material in ACUVUE OASYS(R) Brand Contact Lenses with
HYDRACLEAR(TM) Plus, can alleviate some of the common problems of soft
contact lens wear.

About the Study

At the outset of the study, researchers evaluated clinical data from
1,092 current soft contact lens wearers to calculate the prevalence of six
common signs and symptoms associated with contact lens discomfort. Criteria
included patient reports of frequent or constant discomfort or dryness, and
at least two hours of uncomfortable wear at the end of the day. Nearly half
(48%) showed at least one of the six criteria. Uncomfortable hours of wear
at the end of the day (31%) was the most commonly reported problem,
followed by frequent or constant dryness (28%) and discomfort (17%).

Following the evaluation, 257 wearers were fit with senofilcon A lenses
and reassessed two weeks later. Among subjects who reported problems before
refitting, 88% said they noticed improvement in overall comfort, 76% in
comfortable hours of wear, and 75% in frequency of dryness.

Environmental Factors Can Affect Eye Stress and Strain

While uncorrected or under-corrected vision problems can affect visual
performance and comfort, eye stress and strain may also be caused by poor
environmental conditions, such as glare, improper workstation set up, dirty
screens, poor lighting and viewing angles, according to Dr. Anshel, who has
helped companies and government agencies, including Mitsubishi, American
Airlines, 3M, and the Department of Labor address the high stress area of
vision demands in relation to working with computer monitors.

He offers the following advice to help prevent or reduce the
development of vision-related problems:

– REDUCE GLARE – Extraneous light, or glare, is the greatest source of
eyestrain for computer users. No matter where your computer is relative
to a window, adjustable shades, curtains or blinds should be used to
effectively control light levels throughout the day. Avoid facing an
un-shaded window since the difference in brightness between the screen
and the area behind it may be cause eye stress and discomfort.
Consider using an anti-glare screen to reduce reflections.

– ADJUST YOUR MONITOR – Ideal monitor placement is dependent on several
factors including an individual’s physical make-up and visual
capabilities, work tasks, and other workstation design elements. For
maximum eye comfort, Dr. Anshel recommends placing the center of the
screen five to nine inches below your horizontal line of sight. “You
should be looking just over the top of the monitor in your straight-
ahead gaze,” he says.

– TAKE A BREAK – “Our eyes were not made to see at a close distance for
hours at a time without a break,” says Dr. Anshel. A preventive
approach to reducing visual stress includes occasionally looking away
from the screen of your computer. Dr. Anshel recommends the 20/20/20
rule. “Take a 20-second break every 20 minutes. Focus your eyes on
points at least 20 feet from your terminal. Keep your eyes moving while
looking at objects at various distances,” he says.

– CONSULT YOUR EYE CARE PROFESSIONAL – For individuals whose jobs may
require extensive time in front of a monitor, Dr. Anshel suggests a
comprehensive eye examination soon after beginning computer work and
periodically thereafter. “If, at any time, you experience any vision
problems or discomfort, talk to your eye care professional,” he adds.

For additional tips, take the “Eye Q’s and Views” interactive quiz at
computerquiz.jnjvision.

About the Survey

Americans’ Attitudes and Perceptions About Vision Care was conducted
online and by telephone within the United States from March 8 – March 27,
2006 by Harris Interactive(R) on behalf of The Vision Care Institute(TM) of
Johnson & Johnson Vision Care, Inc. The survey queried a nationally
representative cross section of 3,716 adults aged 18 and older. The survey
was designed to comply with the code and standards of the Council of
American Survey Research Organizations (CASRO) and the code of the National
Council of Public Polls (NCPP). Data were weighted to represent the general
population.

About ACUVUE(R) OASYS(TM) Brand Contact Lenses with HYDRACLEAR(TM)PLUS

ACUVUE OASYS is a breakthrough for contact lens wearers when their eyes
feel tired and dry in challenging environments, such as long hours of
computer use, frequent ground or air travel, or everyday exposure to heated
or air conditioned surroundings. It is the first contact lens made from
senofilcon A, a new silicone hydrogel material that is 50 percent smoother
than currently available silicone hydrogel lenses. In addition to its
smooth feel, the new lens also features HYDRACLEAR(TM) PLUS, an improved
formulation of the unique HYDRACLEAR(TM) technology that combines high
performance base materials with a moisture-rich wetting agent. ACUVUE OASYS
block greater than 96 percent of UVA rays and 99 percent of UVB rays,
meeting the highest UV-blocking standards for contact lenses.[1]

ACUVUE OASYS is indicated for daily wear vision correction and may also
be worn for up to 6 consecutive nights/7 days of extended wear as
recommended by an eye care professional. Contact lenses should not be worn
for longer periods than recommended by an eye care professional. As with
all contact lenses, eye problems, including corneal ulcers, can develop.
Some wearers may also experience mild irritation, itching or discomfort.
Lenses should not be worn if the wearer has an eye infection or experiences
eye discomfort, excessive tearing, vision changes, redness or other eye
problems. For more complete information patients should talk to their eye
care professional, or call 1-800-843-2020 or visit acuvue.

1 Helps protect against transmission of harmful UV radiation to the
cornea and into the eye.

WARNING:

UV-absorbing contact lenses are NOT substitutes for
protective UV-absorbing eyewear such as UV-absorbing goggles or sunglasses
because they do not completely cover the eye and surrounding area. You
should continue to use UV-absorbing eyewear as directed. NOTE: Long term
exposure to UV radiation is one of the risk factors associated with
cataracts. Exposure is based on a number of factors such as environmental
conditions (altitude, geography, cloud cover) and personal factors (extent
and nature of outdoor activities). UV- Blocking contact lenses help provide
protection against harmful UV radiation. However, clinical studies have not
been done to demonstrate that wearing UV- Blocking contact lenses reduces
the risk of developing cataracts or other eye disorders. Consult your eye
care practitioner for more information.

ACUVUE(R) OASYS(TM) and HYDRACLEAR(TM) are trademarks of Johnson &
Johnson Vision Care, Inc.

Johnson & Johnson Vision Care, Inc.
jnjvision

Breakthrough In Eye Cancer Treatment

Scientists at St. Jude Children’s Research Hospital have demonstrated in a mouse model a new, locally applied treatment for the eye cancer retinoblastoma that not only greatly reduces the size of the tumor, but does so without causing the side effects common with standard chemotherapy. The treatment also appears to be suitable for certain forms of breast, lung, prostate and colon cancer, and is simple enough for widespread use even in countries with limited resources.

A report on this work appears in the Nov. 2 issue of the journal Nature.

Retinoblastoma occurs in about 5,000 young children worldwide each year, arising from the immature retina, which is the part of the eye responsible for detecting light and color. The cancer is fatal if left untreated.

The new treatment holds promise for a simpler, more effective and less-toxic treatment for retinoblastoma that would eliminate the need for the current, complex therapy, according to senior author Michael Dyer, Ph.D., a Pew Scholar and associate member of the St. Jude Department of Developmental Neurobiology. The treatment is based on a discovery by Dyer’s laboratory that overturned a widely held belief about the process of apoptosis (cell suicide) in retinoblastoma. Apoptosis is the way the body rids itself of abnormal cells that might become cancerous or cause other problems.

Until now, retinoblastoma experts thought that a mechanism called the p53 pathway triggered apoptosis in other types of cancer cells, but not in retinoblastoma. However, the St. Jude team proved not only that the p53 pathway was activated in early-stage retinoblastoma, but that excessive levels of a molecule called MDMX blocked it from triggering apoptosis in more advanced tumors. Based on this discovery, the St. Jude team used a molecule called nutlin-3 to block MDMX in retinoblastoma cells in test tube studies as well as in mouse models. The molecule was originally developed by Roche Pharmaceuticals (Nutley, N.J.) for a similar use against a related target called MDM2 in adult cancer cells.

The success in knocking out MDMX with nutlin-3 represents the first example of local delivery of a targeted chemotherapy drug for any childhood cancer, Dyer said. Targeted therapy uses a customized drug to disable a specific molecule inside a growing cancer cell; local delivery is the placement of a drug at the site of disease, rather than systemic treatment. In systemic treatment, such as chemotherapy, a drug is infused into the body through a vein and then circulates, often causing toxic side effects that are especially challenging in children.

After demonstrating that nutlin-3 is effective when applied directly to the eye, the St. Jude team modified the treatment by combining this molecule with topotecan, a drug also being investigated in the treatment of retinoblastoma. Local delivery of this two-drug targeted treatment was even more effective, reducing tumor size significantly more than the most effective known combination of standard chemotherapy drugs.

“The findings suggest that this treatment not only could offer children with retinoblastoma more effective and less-toxic treatment,” Dyer said. “It could also increase the chance that their vision can be preserved by eliminating the tumor and preventing its spread from the eye to the rest of the body.”

The discovery that blocking MDMX releases the apoptosis response in retinoblastoma has important implications for certain forms of adult cancers as well. “Some forms of breast, lung, prostate and colon cancer are caused by abnormally large quantities of MDMX in the cells,” Dyer explained. “So knocking out MDMX in those cancers might also dramatically reduce tumor size. And administering the drug directly to the site of the tumor could make the treatment especially effective while avoiding the toxicity caused by systemic exposure.” This could mean the eventual elimination of all-body chemotherapy for certain cancers.

This work is likely to have its biggest impact on the care of children with retinoblastoma internationally, according to Dyer. Most children in the United States with retinoblastoma do not die from the disease because they benefit from early detection and advanced medical treatment. The complex treatment includes chemotherapy, radiation and laser therapy, as well as control of infections caused by treatment-related suppression of the immune system. However, most of the 5,000 children worldwide who are found to have retinoblastoma live primarily in countries with limited resources and have restricted access to medical treatment, according to Carlos Rodriguez-Galindo, M.D., an associate member of the St. Jude Oncology department.

“Today, those children do not have access to the advanced treatments available in other countries, such as the United States,” Rodriguez-Galindo said, “but our new approach has the potential to make the treatment of retinoblastoma simpler and less toxic. Ideally, these treatments could be administered even in countries that cannot afford the highly complex infrastructure now required to manage children with retinoblastoma. This would mean saving many more lives and preserving more vision.” Rodriguez-Galindo is a co-author of the paper.

Retinoblastoma can occur as a unilateral (one eye) or bilateral (both eyes) disease. In the case of unilateral disease, surgeons generally remove the eye that has the cancer in order to prevent the disease from spreading. However, children with bilateral retinoblastoma pose a significant challenge to physicians, who are reluctant to remove both eyes from young children, said Matthew Wilson, M.D., a surgeon in the St. Jude ophthalmology division and a co-author of the paper. In those cases, the physicians institute aggressive systemic chemotherapy to reduce the size of the tumor, followed by one of several possible therapies such as radiation or lasers to destroy the remaining cancer cells in the eye. “When successful, this therapy often saves vision,” Wilson said. “Clinicians at major medical institutions generally save 70 percent of all eyes treated, even in the case of advanced disease.”

Other authors of the paper include Nikia Laurie and Stacy Donovan, co-first authors who contributed equally to this work; Chie-Schin Shih, Jiakun Zhang, Nicholas Mills, Christin Fuller, Adithi Mohan and R. Kiplin Guy (St. Jude); Amina Teunisse, Suzanne Lam, Yolande Ramos and Aart G. Jochemsen (Leiden University Medical Center, the Netherlands); Dianna Johnson (University of Tennessee, Memphis); Micaela Quarto (FIRC Institute of Molecular Oncology, Milan, Italy); Sarah Francoz and Jean-Christophe Marine (Flanders Interuniversity Institute for Biotechnology, Ghent, Belgium); and Susan M. Mendrysa (Purdue University, West Lafayette, Ind.).

This work was supported in part by the National Institutes of Health, Cancer Center Support from the National Cancer Institute, the American Cancer Society, Research to Prevent Blindness, the Pearle Vision Foundation, the International Retinal Research Foundation, the European Community, the Association for International Cancer Research, the Dutch Cancer Society, the Belgian Foundation Against Cancer, T?l?vie and ALSAC.

St. Jude Children’s Research Hospital

St. Jude Children’s Research Hospital is internationally recognized for its pioneering work in finding cures and saving children with cancer and other catastrophic diseases. Founded by late entertainer Danny Thomas and based in Memphis, Tenn., St. Jude freely shares its discoveries with scientific and medical communities around the world. No family ever pays for treatments not covered by insurance, and families without insurance are never asked to pay. St. Jude is financially supported by ALSAC, its fund-raising organization. For more information, please visit stjude.

St. Jude Children’s Research Hospital
332 N. Lauderdale St., Mail Stop 761
Memphis, TN 38122
United States
stjude

Glaucoma Study Compares Medication With Laser Treatments

Fifty million Americans are at risk for vision loss from glaucoma, according to the National Eye Institute.

The second leading cause of irreversible blindness, glaucoma is called the silent killer of sight — the loss of peripheral vision is gradual and can go unnoticed.

Louis B. Cantor, M.D., who specializes in glaucoma treatment, says public awareness is an important factor in increasing the number of people being screened and receiving early treatment. Expanding treatment options for glaucoma also is important, he says.

Currently, patients begin with a regimen of medicated drops. As the disease progresses, patients may graduate to laser treatments and, finally, surgery. Dr. Cantor, who is the Jay C. and Lucile L. Kahn Professor with the Indiana University School of Medicine Department of Ophthalmology and director of the IU Glaucoma Service, is participating in a multi-site clinical trial comparing medicated drops to laser treatment as the first line of therapy.

“There are advantages and drawbacks to both treatments in terms of convenience, compliance, effectiveness and expense,” said Dr. Cantor. “Lowering the pressure in the eye is the goal of glaucoma treatment. This study should indicate which treatment is most effective for lowering the pressure in the eye for the longest period of time, thereby reducing the risk of vision loss.”

Individuals with open angle glaucoma may call Joni or Linda at 317-274-2745 for additional information on the trial.

October has been designated as Glaucoma Awareness Month by the American Academy of Ophthalmology.

Dr. Cantor said individuals need to be informed to protect themselves from vision loss. Those most at risk for glaucoma are:

— People over age 50
— African-Americans over age 40
— People with other health conditions, such as diabetes (exam every year)
— Individuals that have experienced a serious eye injury
— People with a family history of glaucoma

Initially, there are usually no symptoms, but as the disease progresses a person with glaucoma may notice his or her vision gradually failing with:

— Blurred vision
— Loss of peripheral vision
— Difficulty focusing on objects
— Presence of halos around lights

Individuals at risk should have a complete eye exam every year or two, said Dr. Cantor.

indiana.edu

Patients Suffer Due To PBS Limits, Australia

Limitations on the prescribing of PBS listed medications come at a substantial cost to patients who can least afford it, according to the Optometrists Association Australia.

Incoming national president of the Optometrists Association Australia, Mr Andrew Harris said that more than 7,500 patients a year in Victoria, Tasmania and Queensland are being sent back to their GP by optometrists to get a PBS eligible script.

He said that new regulations will disadvantage patients who most need help.

“Optometrists can prescribe up to 45 medicines in most States, but under government regulations only 12 of these receive a Pharmaceutical Benefits Scheme (PBS) benefit as of January 1, 2008,” said Mr Harris.

“Patients on low incomes, those with mobility difficulties and patients in rural and remote areas who have least access to specialist care will be most disadvantaged.

“Rather than having the patient pay the full price for the prescription an optometrist will generally send their patient to a GP who will write the script the optometrist has recommended,” Mr Harris said.

“The new regulations introduced under the previous government are a step in the right direction but were limited to appease a small section of the medical fraternity.”

Optometrists Association Australia is calling on the Rudd Labor Government to review the PBS list and grant PBS access that will benefit all patients who need it.

Optometrists Association Australia

EyeIC Receives FDA 510(k) Clearance For MatchedFlicker(TM) Retinal Aid Detection Technology

EyeIC, an innovator of eye care solutions for ophthalmologists and optometrists, announced today that its MatchedFlicker(TM) technology has received FDA 510(k) clearance from the United States Food & Drug Administration (FDA). MatchedFlicker is a device-agnostic, software-only solution that uses time series retinal photographs to help doctors monitor the advent and progress of glaucoma faster and with accuracy now available to only a few experts.

The technology enables eye care professionals to compare two retinal images taken at different visits from the same patient — from nearly any source — and see change brought to life as motion. After the doctors make their evaluations, they have the ability to mark the changes on the flicker and on the images. The software also translates markings made on any image in a Flicker project to the appropriate location on all other images in the same project. All images and annotations are saved in an electronic format and can be printed.

“We are very optimistic that our MatchedFlicker technology will address the pervasive problem of early change detection in glaucoma,” said Ira Wallace, CEO of EyeIC. “Currently, the gold standard for detecting retinal changes is done by glaucoma trained experts that compare separate pairs of stereo photos side by side, which makes it difficult to find and document changes between images. MatchedFlicker provides eye care professionals with a technology for faster detection, improved documentation and an easy-to-use electronic format that enables collaboration among multiple doctors across town or across the globe.”

EyeIC’s technology is an aid to change detection that addresses a rapidly growing market for glaucoma monitoring. In the U.S., glaucoma is the second leading cause of irreversible blindness with 10% of the population over the age of 40 at risk (World Glaucoma Association). It is estimated that over four million Americans have glaucoma, but only half of those know they have it (Prevent Blindness America). The U.S. Department of Labor estimates approximately 56,000 eye care professionals in the U.S. today.

“EyeIC’s MatchedFlicker offers ophthalmologists a powerful new tool for the detection of progressive glaucoma,” said Nathan Radcliffe, M.D., Director of Glaucoma at Weill Cornell Medical College and New York-Presbyterian Hospital. “MatchedFlicker automatically aligns and alternates serial optic disc photographs, allowing the clinician to quickly inspect each photographic set for small changes of the neuroretinal rim and vasculature.”

Radcliffe added, “Subtle features that might escape detection on side by side review of photographs, such as faint disc hemorrhages or peripapillary atrophy progression, can be spotted easily and in a matter of seconds. The software package is intuitive to use and offers a variety of mark-up tools that facilitate report generation and will work well with most EMRs. In my practice, MatchedFlicker has allowed me to make excellent use of historical optic nerve photos and plays a unique role in the detection of progressive glaucoma.”

EyeIC was founded in 2004 with a portfolio of intellectual property from the University of Pennsylvania. In November, the company completed a Series A round of $1.9 million in fundraising from MentorTech Ventures, Ben Franklin Technology Partners, private investors and its founder.

“We are extremely pleased with EyeIC’s the 510(k) clearance for MatchedFlicker,” said Michael B. Aronson, a Board Member of the Company and Managing Director of MentorTech Ventures. “I am impressed by the Company’s business model for developing innovative software products that will dramatically improve the diagnostic standard of care for a large number of people afflicted with eye disorders.”

EyeIC expects to make available a commercial solution that fully integrates into the current workflow of the eye doctor’s office by July of 2009. The company will exhibit at the World Glaucoma Congress on July 8-11 in Boston.

About EyeIC

EyeIC is a medical device company focused on eye care solutions. The company has developed its MatchedFlicker(TM) technology that allows eye care professionals to better monitor the progression of glaucoma and other eye diseases through faster detection and improved interpretation and documentation of retinal photographs. EyeIC was founded in 2004 with a portfolio of intellectual property from the University of Pennsylvania and recently completed a Series A round of $1.9 million in fundraising from MentorTech Ventures, Ben Franklin Technology Partners, private investors and its founder.

Source: EyeIC

Early Light Refines The Brain’s Circuitry For Vision

Creatures are not born hardwired to see. Instead, they depend on electrical activity in the retina to refine the complex circuits that process visual information. Two new studies from Brown University in different species using different techniques show how nascent animal brains use light to wire up or construct their central vision system.

Any parent knows that newborns still have a lot of neurological work to do to attain fully acute vision. In a wide variety of nascent animals, genes provide them with only a rough wiring plan and then leave it to the developing nervous system to do its own finish work. Two studies by Brown University researchers provide new evidence of a role for exposure to light in the environment as mouse pups and tadpoles organize and refine the circuitry of their vision systems.

“Through a combination of light-independent and light-dependent processes, the visual system is getting tuned up over time,” said David Berson, professor of neuroscience.

His new work, published in advance online June 5 in Nature Neuroscience, offers the surprising result that light exposure can enhance how well mice can organize the nerve endings from their left eye and their right eye in an area of the brain where they start out somewhat jumbled. Neuroscientists had thought that mammals were unable to see at this stage, but a new type of light-sensitive cell that Berson discovered a decade ago turns out to let in the light.

Meanwhile, Berson’s colleague Carlos Aizenman, assistant professor of neuroscience, co-authored a paper online May 31 in the Journal of Neuroscience showing that newborn tadpoles depend on light to coordinate and improve the response speed, strength and reliability of a network of neurons in a vision-processing region of their brains.

“This is how activity is allowing visual circuits to refine and sort themselves out,” said Aizenman. “Activity is fine-tuning all these connections. It’s making the circuit function in a much more efficient, synchronous way.”

Not completely blind mice

Berson, postdoctoral scholar Jordan Renna, and former postdoctoral researcher Shijun Weng conducted several experiments in newborn mice to see whether light influences the process by which the mice rewire to distinguish between their eyes.

“For certain functions, the brain wants to keep track of which eye is which,” Berson said. Among those functions are the perception of depth and distance.

At a circuit level, the brain keeps signals from the two eyes distinct by segregating their nerve endings into separate regions in the dorsal lateral geniculate nucleus (dLGN), a key waystation on the path to the visual cortex and conscious visual perception. Scientists have long known this sorting-out process depends on waves of activity that spontaneously excite cells in the inner retina. They did not know until now that the waves are influenced by a light-sensitive type of cell called intrinsically photosensitive retinal ganglion cells (ipRGCs).

About a decade ago, a team Berson led at Brown discovered the ipRGCs, which are the first light-sensitive cells to develop in the eye. They reside in the inner retina, the home of retinal cells that send visual information directly to the brain. The outer retina is where the more familiar rods and cones sense light. Early in life, when the brain is segregating nerve endings into distinct regions in the dLGN, the two retinal layers are not connected, so until ipRGCs were discovered there was no reason to believe that light would affect the sorting process.

The new research doesn’t say anything definitive about the consequences of light exposure at this stage for eyesight in adults, especially given that some mammals (such as monkeys) experience this developmental stage in utero.

“Whether different animals in nature are exposed to enough light to induce a change in segregation patterns is unclear,” Renna said.

But the research shows that light exposure does improve how well the sorting goes, Berson said, and the work advances neuroscientists’ understanding of the eye-distinction process, which is widely studied as a model of “activity-driven” neural development.

To assess the effect of light on retinal waves, Renna used electrodes to record the activity of cells in the inner retinas of newborn mice, first recording in the dark, then in the light, and then again in the dark. In every case retinas experienced waves, but when the retinas were exposed to light, the waves lasted about 50 percent longer.

Renna then tested whether the light-sensitive cells were really creating this wave-lengthening effect by repeating the study in “knock-out” mice in which the ability of the ipRGCs to sense light had been genetically abolished. With the cells disabled, exposure to light no longer made any difference in the duration of the waves.

Finally, to assess the effect of light on the left-right sorting process in the dLGN, Renna examined the tissues from normal mice and the mice whose ipRGCs couldn’t sense light. In each case he fluorescently labeled the nerve endings from one eye red and the other green. A computer comparison of the tissues showed that the normal mice developed a higher degree of segregation between red and green than the knockout mice. In other words, the ability of ipRGCs to sense light improved sorting out one eye from another in the dLGN.

Twinkling tadpoles

In his study, Aizenman collaborated with Arto Nurmikko, professor of engineering and physics, to investigate the function of in the optic tectum of tadpole brains. They flooded the tectal neurons in live tadpoles with a molecule that makes calcium ions fluoresce. As whole networks of neurons became active, they’d take in the ions and glow. The researchers recorded the tadpoles with a high-resolution, high-speed camera that could capture the millisecond-to-millisecond activity of the neurons.

Led in the lab by engineering graduate student Heng Xu, the lead author, and postdoctoral researcher Arseny Khakhalin, the team reared some young tadpoles under normal conditions of 12 hours of light and 12 hours of darkness during the crucial days of development when the tectum is developing. They reared others in the dark, and still others with a chemical that blocks the activity of NMDA receptors, a subtype of receptor to the neurotransmitter glutamate, that is known to promote neural rewiring.

Then they exposed all the tadpoles, however they were reared, to blue LED light flashes delivered via a fiber optic cable mounted next to the eye.

What they found over the course of several experiments was that the neural networks in the tectums of tadpoles reared under normal conditions developed a faster, more cohesive, and stronger response (in terms of the number of neurons) to light.

The tectal neural networks of tadpoles kept in the dark during development failed to progress at all. Those whose NMDA receptors were blocked occupied a middle ground, showing more progress than dark-reared tadpoles but less than normal tadpoles. Tadpoles, they found, train their brains with the light they see.

Aizenman said he hopes the calcium ion imaging technique will prove useful in a wide variety of other neuroscience experiments, including studying how tadpoles neurally encode behaviors such as fleeing when they see certain stimuli.

In the meantime, his team and Berson’s have added to the understanding scientists have been building of how creatures turn the somewhat mushy approximations of their brains at birth into high-functioning animal minds.

“That’s what everybody is after,” Aizenman said. “How do you get this fine-tuned, finely wired brain in the first place?”

Berson and Renna’s work was funded by the National Institutes of Health. Aizemnan and Nurmikko’s research received support from the National Science Foundation, the NIH’s National Eye Institute, and the Whitehall Foundation.

Source:
David Orenstein
Brown University